European journal of medical research · 2025
External validation of the updated international IgA nephropathy prediction tool in a Chinese population.
СтатьяВалидационное исследованиеНазвание и аннотация: Перевод в очереди
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Du Xinru, Zhou Jing, Ma Mingqi, Yu Hongyu, Lv Jia, Lu Xuehong
Аннотация
OBJECTIVE: The updated post-biopsy International IgA Nephropathy (IgAN) Prediction Tool (IIgAN-PT) requires validation in diverse clinical settings. We evaluated its performance in a Chinese cohort characterized by severe pathology and aggressive immunosuppression therapy.
METHODS: Patients with biopsy-confirmed IgAN from two medical centers in China were included. We calculated the predicted risk for each patient. The primary outcome was the first occurrence of end-stage kidney disease(ESKD, eGFR < 15 ml/min/1.73 m2, dialysis or transplantation) or a permanent decline in estimated glomerular filtration rate to less than 50% of the baseline time value at one year after kidney biopsy. Model performance was assessed by discrimination, calibration, and reclassification.
RESULTS: In our cohort, 14.1% of patients experienced the primary outcome. The updated post-biopsy IIgAN-PT did not demonstrate significantly superior discriminatory ability as compared to the original biopsy IIgAN-PT. Kaplan-Meier curves for risk subgroups showed poor separation in low- and intermediate-risk groups but marked separation in the high-risk group. However, the calibration performance of the post-biopsy IIgAN-PT improved. The updated IIgAN-PT significantly improved the Net Reclassification Index(NRI) compared to the original IIgAN-PT, but showed limited improvement in Integrated Discrimination Improvement(IDI) for clinical risk reclassification. Subgroup analysis indicated that immunosuppression therapy significantly reduced the model's discriminatory ability.
CONCLUSION: In this external validation, the updated post-biopsy IIgAN-PT demonstrated improved calibration over the original IIgAN-PT for risk assessment at 1-year post-biopsy, leading to more accurate absolute risk estimates. However, due to the limitations of the updated IIgAN-PT in distinguishing between low-risk and intermediate-risk patient groups, its application value for refined risk stratification in clinical decision-making is constrained. Registry: Chinese Clinical Trial Registry, TRN: ChiCTR2400093550, Registration date: 06 December 2024.
METHODS: Patients with biopsy-confirmed IgAN from two medical centers in China were included. We calculated the predicted risk for each patient. The primary outcome was the first occurrence of end-stage kidney disease(ESKD, eGFR < 15 ml/min/1.73 m2, dialysis or transplantation) or a permanent decline in estimated glomerular filtration rate to less than 50% of the baseline time value at one year after kidney biopsy. Model performance was assessed by discrimination, calibration, and reclassification.
RESULTS: In our cohort, 14.1% of patients experienced the primary outcome. The updated post-biopsy IIgAN-PT did not demonstrate significantly superior discriminatory ability as compared to the original biopsy IIgAN-PT. Kaplan-Meier curves for risk subgroups showed poor separation in low- and intermediate-risk groups but marked separation in the high-risk group. However, the calibration performance of the post-biopsy IIgAN-PT improved. The updated IIgAN-PT significantly improved the Net Reclassification Index(NRI) compared to the original IIgAN-PT, but showed limited improvement in Integrated Discrimination Improvement(IDI) for clinical risk reclassification. Subgroup analysis indicated that immunosuppression therapy significantly reduced the model's discriminatory ability.
CONCLUSION: In this external validation, the updated post-biopsy IIgAN-PT demonstrated improved calibration over the original IIgAN-PT for risk assessment at 1-year post-biopsy, leading to more accurate absolute risk estimates. However, due to the limitations of the updated IIgAN-PT in distinguishing between low-risk and intermediate-risk patient groups, its application value for refined risk stratification in clinical decision-making is constrained. Registry: Chinese Clinical Trial Registry, TRN: ChiCTR2400093550, Registration date: 06 December 2024.